There is an ongoing and predicted long-term shortage of licensed pharmacists. Due to the increasing age of the population and the ever-increasing number of prescription medicines available, the demand for prescription drugs is growing at a rate that will far exceed the capacity and numbers of licensed pharmacists. The net impact of this imbalance is that pharmacists are increasingly spending more time doing clerical and administrative tasks such as verifying filled prescriptions and checking data entry done by pharmacy technicians. Since the capacity of any one pharmacist is fixed, the output of a pharmacy has become constrained. Consequently, the labor and total cost per prescription continues to rise. The December 2000 Department of Health and Human Services Report to Congress titled “The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists”, which is hereby incorporated by reference into the present application, provides an overview of the above problem.
Due to these increased demands on a pharmacist's time, and the resulting increased reliance on technicians and other non-professional staff to fill prescriptions, there is an increased chance for prescription error. While these errors may take many forms, the likelihood of a dangerous or life threatening “adverse drug event” increases proportionally with the increased chance of prescription fill error. Several studies have shown that prescription error rates are consistently in the 2% to 7% range, with a 4% error rate often cited as a reliable average. The number of deaths due to medication errors is estimated to exceed 7,000 per year in the United States alone. Of course, this number does not include non-fatal conditions from drugs that also result in some form of trauma or injury. The resulting litigation costs associated with these prescription fill errors have also dramatically increased.
Many existing pharmacy filling systems and procedures still require a human operator, whether that operator is a technician or a licensed pharmacist, to validate visually whether the drug that is delivered to the customer is correct. Thus, the human factor can contribute to the majority of prescription fill errors. Existing visual verification techniques typically rely on comparing an electronic image of the prescribed medication, i.e., a picture of the prescribed medication retrieved from a data library, with the actual medication that is dispensed for the patient. Other systems and procedures rely on comparing the dispensed medication with that in the original manufacturer's supply container, or comparing an electronic image of the filled prescription with an electronic image of the prescribed medication retrieved from a data library.
Each of these verification systems presents similar problems. First, these known verification methods assume that all drugs are visually distinct. This assumption causes many problems because many drugs are not, in fact, visually distinct and, in other cases, the visual differences between drugs is very subtle. For instance, manufacturers are rapidly running out of unique shapes, colors and sizes for their solid dosage form products. To further complicate the problem, generic drug manufactures may be using shapes, colors, and sizes that are different than that of the original manufacturer. Second, even though some known systems may utilize a National Drug Code (NDC) bar code to verify that the supply bottle being accessed corresponds correctly to the patient's prescription, a fraction of filled prescriptions that are never picked up are returned to the supply shelves for reuse in later prescriptions. These reused bottles will not, therefore, have a manufacturer's bar code on them. It is difficult, if not impossible, to incorporate such validation schemes for these unused prescriptions. Furthermore, in these circumstances, a supply bottle is not available for a visual comparison with the filled prescription. Finally, each of these known manual verification and validation techniques typically requires that the pharmacist spend a significant portion of his day performing these administrative or clerical tasks and allows less time for patient consultation and other professional pharmacist activities.
Solid dosage pharmaceuticals (e.g. pills, tablets, and capsules) each have a unique chemical composition associated with them. This is often referred to as a chemical signature or fingerprint. Pharmaceuticals with varying dosage levels of the same active ingredient may have unique chemical signatures as well. Even slight variations in the active ingredient typically produce a unique chemical signature. In that regard, most pharmaceuticals can be identified accurately by the use of some form of chemical analysis. This same methodology may be applied to other forms of medication (e.g. liquids, creams, and powders). Particularly with solid dosage pharmaceutical products, while a group or package of products may look identical in the visible portion of the spectrum each product may have a unique chemical signature in the near-infrared wavelength range (800 to 2500 nm). For example, U.S. Pat. No. 6,771,369 to Rzasa et al. describes a pharmaceutical discrimination system that relies on NIR for scanning the contents of a pharmaceutical vial. As another example, U.S. Pat. No. 7,218,395 to Kaye et al. describes the use of Raman spectroscopy for scanning vial contents. U.S. Patent Publication No. 20080183410 describes another spectroscopy-based discrimination system that can analyze pharmaceuticals as they are present in a capped pharmaceutical vial.
Although these spectroscopy systems can be very accurate, in many instances it may be necessary or helpful to verify the identity of the pharmaceutical visually. Naturally, if the pharmaceutical has already been dispensed into a vial, removal from the vial (or even uncapping of the vial) can slow the dispensing process. However, it is common for pharmaceutical vials to be largely transparent and have an amber color. The use of amber-colored vials began as an attempt to preserve the potency of the pharmaceuticals contained therein (based on the belief that amber coloration helped to prevent the passage of UV radiation, which might damage the pharmaceuticals), and their use has continued as a matter of convention. Thus, the use of a conventional vision system to verify the contents of a vial visually is difficult, because often the color of the pharmaceutical is one of its most distinguishing characteristics, and the amber color of the vial can adversely affect the accuracy of the color presented to the vision system.
One solution to color identification and verification is discussed in U.S. patent application Ser. No. 12/249,402, filed on Oct. 10, 2008, the disclosure of which is hereby incorporated herein in its entirety. This system includes an analysis chamber camera assembly that can capture an image of medication pills through the bottom surface of an amber or other color transparent vial. The system includes a bowl shaped chamber into which light is dispersed. A window at the “base” of the bowl allows light to reach the bottom surface of the vial. The shape of the chamber can minimize reflections on the chamber window. The use of an anti-glare coating on the chamber window can also contribute to keeping light glare/reflection at a minimum. An LED light ring is used to evenly disperse the light throughout the bowl chamber. A light curtain is used to block direct light from the LEDs to further assist in reducing light glare/reflection. Certain surfaces may be painted white where light is channeled for efficiency, and others may be painted black to eliminate glare.
The LED light ring includes multiple sets of LEDs, alternated and symmetrically arranged along the light ring's edge to provide uniform illumination such that light intensity from a given wavelength is balanced in each direction. The color of the light from the LEDs mounted on the ring may be monochromatic in the visible range (e.g. red, green, blue) and may be adjusted to “cancel” the color of the vial. The structure of the light ring is discussed in U.S. patent application Ser. No. 12/623,878, filed Nov. 23, 2009, the disclosure of which is hereby incorporated herein in its entirety.
The ring is configured to allow independent control of the light intensity of the different colors. The ring can also be set up so that the intensity of all the colors can be changed together, but equally balanced. This design can allow automatic color adjustment of a vial type of any color of transparent material.
Although this system may provide versatility, imaging techniques may still be improved for certain drugs, vials, or combinations thereof.